Achilles Healing - Tom’s Road to Recovery

26 Months 13 days Post Op #2

It’s been a year since my last post and 3 years and 10 months since my initial injury and surgery.  I still check in at achillesblog from time to time, but generally leave the commenting to the newer crop of rupturees.  I decided to add another post because I notice the “healing long” topic comes up every few months, and I know there aren’t many resources available for reference.  So, as one who “healed long”, I’m including an update to give a long range perspective now that it’s been over two years since I had a second surgery to shorten the tendon.

Life is back to “normal” in the same way it has been for the last year.  The injury is still a part of my life, but it doesn’t hold me back from doing or trying the activities I enjoy.  Running continues to be my main source of exercise and I completed another marathon earlier this month, my second since the injury.  I finished up a few minutes faster than last year, achieving my main goal, and just a minute off my personal best.  I can’t help but think that I would have cut several more minutes off my time if I wasn’t still trying to overcome this injury.  Aside from a break during marathon training, I still work on strengthening my calf which continues to be the main shortfall of my recovery.

The rehab from the second surgery has lasted much longer than I ever imagined.  My surgeon did warn that it could take 18 months, but of course I felt like I’d be back to normal within a year.  18 months passed and I was still concerned/disappointed with my recovery.  I made some slow progress, but my calf strength was still lacking and I was dealing with some nagging tenderness in my heel.

Eventually I decided to meet with a new ortho just to seek a different opinion.  I was fortunate enough to get in contact with a foot & ankle specialist who was not only familiar with achilles reconstruction as a surgeon, but also as a patient.  Dr. C had chronic issues with his ATs which eventually required surgery a few years ago.  He had lengthening issues in both tendons following surgery, and eventually had shortening surgeries performed on both legs.  One leg even required a third surgery.  My appointment with him was very surreal.  I felt like we were a couple of war veterans swapping combat stories.  Unfortunately, I got so caught up with talking to him as a person and fellow patient that I forgot to ask many of the medical questions I had such as, “What can cause a tendon to heal long?”.

After comparing calves and recovery stories, Dr. C described a tendon augmentation surgery that could improve my situation.  However, he quickly recommended against such a surgery as he felt the potential benefits were likely to be minimal and not worth the inconvenience of another surgery.  Hearing a surgeon recommend against surgery just about knocked me out of my chair, but it made his opinion that much more valuable.  At that point I felt I had explored all my options, and determined that time and continued strength training were my best options for getting closer to 100%.

It’s been 6 months since I met with Dr. C and I’m happy that I continue to notice some small improvements.  My right calf is still weak when compared to my left leg, but it is better than it was earlier this year and definitely better than it was prior to the second surgery.  The tenderness that I constantly felt in the tendon finally dissipated within the last few months and my ankle movements feel more fluid and natural.  I still struggle a bit with single leg heel raises.  I can’t quite get the last bit of push to really extend up onto my toes.  I’m able to do so if I cheat a little bit and use my finger tips to help with balance and offset a bit of weight, but still a bit weak. My running stride is also a little weak and I still feel I’m recruiting other muscles to offset the lack of calf strength.  But, this too is better than where it was 6 months ago.  I may try some different things with my stride, such as shortening it, now that I’m done marathon training for awhile.  We’ll see if that makes any difference.  In the end, I think it just comes down to calf strength.

So, where do I go from here?  The last few months have been encouraging even though my calf is still not as strong as I’d like it to be.  It’s good to know I’m still making progress given that the second surgery was over two years ago.  I’m somewhat resigned to the fact that a 100% recovery is not in the cards for me, but it doesn’t mean I can’t continue to move forward.  If I had to guess, I would say I’m somewhere around 75-80%.  As I mentioned earlier, the missing strength doesn’t keep me from doing anything I want to do, but I’m not able to do things quite as well as before the injury.  I can’t jump as high or as long, but I can still jump.  My running stamina may not be as strong, but I’m still able to run long distances.  So, overall I can’t complain much.  The last goal I’d like to achieve is to get to a point where I don’t think about my calf or tendon when attempting to jump or hop on my right leg.  Hopefully that happens soon.

Healing long seems to be a poorly documented and/or understood complication of an achilles injury.  Fortunately for those concerned, I’m sure the main reason for the lack of information is the infrequency of the condition.  It is something to be aware of during rehab, but hopefully not something that creates any more concern than the injury itself.

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14 Months 5 days Post Op #2

33 months to the day of my Achilles rupture and two surgeries later I finally achieved my primary recovery goal.  After all the highs and lows and twists and turns of this journey, I finished another journey this past Sunday by completing my first post-ATR marathon.  The race went well and I didn’t notice any unusual soreness with the Achilles during or after the race.  Perhaps the soreness in my hips and thighs is masking any AT pain??

My recovery from the second surgery is still a work in progress.  As a quick recap for some of the newer bloggers, my AT healed long following the original rupture and surgery and I had a second surgery to shorten the tendon.  I’m now 14 months post-op from the shortening surgery and I continue to experience some tenderness and stiffness in the tendon.  In addition, my calf is still weaker than I’d like it to be.  However, all of these symptoms are improving, especially when I compare how things felt 3 and 6 months ago.

I checked in with my surgeon back in June and he was not concerned about my progress.  His opinion was that the tenderness was likely the result of multiple surgeries and the subsequent scarring that built up around the tendon.  He advised to give it more time and continue exercising as long as it isn’t too painful to do so.  I was also reminded of a comment he made prior to the second surgery in which he said it could take up to 18 months before I know the success of the surgery.  I was hoping to realize faster progress, but it looks like his timetable may be pretty accurate.

The healing process continues to remain a significant part of my life.  The tendon is still the first thing I think about when I wake up and the last thing when I fall asleep at night.  More and more I find that I’m doing some small, reactive movements without thinking about the tendon, but I’m still looking forward to the day I start jumping and running without any reservations.  I’m hopeful this will happen once more strength returns to my calf.

I’m glad that my experience with this injury is still a rarity, and that most of you continue to heal well and on schedule.  However, I hope that my experience may be helpful for those who’s recovery does get sidetracked for one reason or another.  Try to remain positive and don’t give up.  While I’ve finally achieved my primary goal of running another marathon, I know that I still have plenty of work to do to improve my calf strength and hopefully one day put this injury to the back of my mind.

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28 Weeks 6 Days Post Op

It’s been awhile since my last post, as seems to be typical at this stage of recovery.  I am now around 6.5 months post-op from the second surgery, and while I try to put this injury to the back of my mind, it still remains a top priority.  I guess I just haven’t felt a need to post much lately as my recovery is still moving along slowly.  The tendon is still a bit tender when it’s stretch to the extents and during some lateral movements, but it is better than the last time I posted.  My calf is a bit stronger, but still far from normal.

I just started receiving the Graston massage treatment when I last posted .  I ended up having a total of about eight Graston sessions.  I noticed some improvements during the first three or four sessions, but then the results started to plateau.  My PT decided to switch to ultrasound to help break down and even out the scar tissue.  The ultrasound may be helping as my tendon feels a bit more pliable than it did a few weeks ago, although it’s difficult at this stage to determine how much of a factor time is to my healing.

In addition to the manual therapy, I continue to work on an endless array of exercises to improve my strength and balance.  It feels like I could spend 2 hours at the gym and still not get through all the exercises.  So, I do my best to attain a good, daily balance of strengthening, balance, and cardio exercises.  I have recently advanced to some plyometric exercises which should help build some explosive power back into my leg.

I also started to ease back into running.  Over the last couple of weeks I’ve progressed from two minute intervals of running up to about five minute intervals, with a couple minutes of walking in between the intervals.  There is definitely a fair amount of fatigue in my leg, so I’m cautious not to progress to quickly.

While I occasionally get discouraged about my calf strength progress, I remind myself that my current recovery is a bit different than a standard ATR recovery.  I went into the second surgery with a calf that was probably at half its normal strength, so I’m trying to overcome a fair amount of atrophy.  My surgeon told me prior to surgery that it could take a year and a half to get back to full strength.  If that’s the case, I can’t be too upset with my current status.  Hopefully the tenderness will continue to subside and I’ll be able to get a bit more aggressive with the strengthening exercises.

Cheers!

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22 Weeks 4 Days Post Op

It was 2 years ago on this day that I originally ruptured my Achilles.  Hard to believe as I never would have thought then that I’d still be dealing with the injury today.  But, I am and fortunately I’m still able to stay positive.  So tonight I’m celebrating my 2 year anniversary.

I am now just past 5 months post op from the second surgery to shorten my tendon.  My progress has been slow, but I feel like that is starting to change.  I’ve had three sessions of the Graston massage technique and it seems to be helping to loosen the tendon and put a little spring back in my step.  It just feels like my calf is starting to engage a bit more over this past week.  I’m hopeful this is a trend that will continue and allow me to build back more strength into my withered calf.

Along with the Graston technique, I continue with a daily routine of strengthening, balance, and stretching exercises.  I’m still holding off from running, but I hope to test that again in a few weeks.  I rely on the elliptical, stationary bike, and swimming for cardio workouts.

I’ve also been getting a pretty good workout from walking the dog the last several days.  We received a wonderful mix of snow and rain just prior to the holidays that has covered all the sidewalks with ice.  My tendon repair is tested almost daily when I need to catch my balance to keep my feet from sliding out from under me.  No problems so far.

Attached below are a couple of current photos.  The incision has healed pretty well.  The tendon is thick although no worse than expected.  A little shape has returned to the calf, but still a long way to go.  Hopefully it will look even better next month.  Until then, happy healing!

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20 Weeks 6 Days Post Op

At my last follow up appointment my surgeon suggested trying a deep massage technique called Graston to determine if some of the discomfort I’ve experienced is related to the scar tissue and any adhesions around the tendon.  My physical therapist was not certified with the Graston technique, so I needed to find a new one.   Fortunately I found a PT clinic that is convenient to both home and work.

Today I had my first appointment with the new PT and my initiation with Graston.  Several people with first hand knowledge gave me fair warning of the pain that can be involved.  I also read that people with red hair and fair skin may find the treatment more painful.  Of course, I have both red hair and fair skin.  But, I was more excited to try something new rather than nervous of the possible pain.

After discussing my long history with this injury and the science of Graston, the PT got to work.  I was pleasantly surprised that I didn’t find the technique to be all that painful.  I don’t consider myself to have an unusually high pain threshold, so I’m sure the level of pain is different for everyone.  I believe the PT also mentioned that she would probably start off a bit easy to see how my body reacted to the treatment.  Perhaps the pain will come later??

It is obviously too early to tell if the Graston massage was helpful, but my ankle and calf did feel a bit looser following the treatment.  The PT mentioned that it generally takes about 3-4 sessions to notice if Graston is providing any benefit.  I’m hopeful that I’ll see some improvements by the end of the year.

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20 Weeks Post Op

It has now been 20 weeks since my second Achilles surgery.  Progress is occurring, but it is slow.  Definitely testing my patience.  I’m still dealing with some discomfort at the distal end of the tendon and a bit of overall stiffness in the ankle which is probably a cause of the slow progress.  I continue to work with a physical therapist about once a week and do plenty of daily exercises at the gym and in the pool.

I had a follow up appointment yesterday with my surgeon.  It was a good chance to discuss my progress in person.  Like my PT, the surgeon wasn’t too concerned about the discomfort/tenderness/pain as he felt everything looked like it was healing properly.  He reiterated that my tendon has gone through a lot of trauma in the last two years, and it will likely just take some more time to feel more comfortable.  While I understood his response and know that time is definitely a part of the healing process, I pressed him a little further to see if there wasn’t anything more I could do besides the PT exercises and playing the waiting game.  After a bit more discussion he suggested trying the Graston technique of tissue massage to help break down some of the scar tissue. 

I am somewhat familiar with the Graston technique from reading about the process following my first surgery, although I never pursued it further.  I understand the technique can be a bit painful the first few times, but that’s not a concern if it helps my healing.  I am definitely eager to give something else a try. 

So, now I’m searching for a therapist who is qualified to administer the Graston technique.  I will keep you posted on the results.  Cheers!

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16 Weeks 1 Day Post Op

It’s been several weeks since my last post, so I thought it was time for another update.  The 16 week mark kind of crept up quickly on me.  Unfortunately I have little to report as the progress has been a bit slow.  I try to remind myself that the progress is significant when compared to my first steps without the boot.  But, my leg is still weak, tendon is still a bit tender and stiff, and I’m getting more and more anxious to start running and jumping again.  I remember some similar feelings following my initial surgery, so I guess I shouldn’t be surprised.

I mentioned in my last post that I was experiencing some minor discomfort in the bottom end of the AT.  I’ve seen some improvement, but there is still some tenderness when the tendon is stressed in certain ways.  The discomfort has limited strength training to some extent, but I’m still doing plenty of exercises to get the tendon and my leg back to normal.

I continue to go to PT once a week and get a few new exercises each time.  My therapist is not alarmed by the tenderness I’ve experienced and indicated that it’s likely just a result of the tendon adjusting to increased activity.  He feels I should keep at it as long as the pain doesn’t get any worse. 

So, I’ll continue to press on and hope to find that balance of doing enough but not too much.  Hopefully the upcoming weeks will bring about more progress.  Cheers!

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13 Weeks 1 Day Post OP

I’ve experienced a bit of discomfort in my heel over the last week since I ditched the boot in favor of two shoes.  Not necessarily painful, just tender.  It is very localized in the area where the tendon joins into the calcaneus.  Longer periods of walking seem to elevate the level of discomfort, but it does dissipate a bit with massage, ice, and rest.

While at my appointment this morning I spoke with my physical therapist about the tenderness and he did not seem too concerned.  He felt it was pretty normal to have some discomfort at this stage.  It is most likely a bit of inflammation or just the tendon adjusting to increased activity.  Sounds like there is no reason to make any changes to my exercises at this point, but I need to make sure I continue to ice the tendon and take a day off after strengthening exercises.

Other than the minor discomfort I feel like I am healing well up to this point.  I’ve progressed past the basic range of motion exercises and into balance and strengthening.  I’m currently working on single leg balance (with eyes closed or on a piece of foam for an additional challenge), resistance strengthening with Therabands, and shallow squats (both double and single leg).  I’m also riding the stationary bike and walking several times a week.  I look forward to taking longer walks and increasing the intensity on the bike once the tenderness subsides.  Cheers!

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12 Weeks Post Op

I visited with my surgeon yesterday and he gave me the okay to retire the boot.  The surgeon felt the tendon for a couple of seconds and then compared the tension with my good leg and declared that everything was healing well.  I can continue my rehab with no restrictions.  I’ll return in two months for another follow-up.

So, it’s now time to say goodbye to a close friend.  With autumn upon us and the weather changing rapidly, I will be relegating my stylish boot to a deep, dark corner of the closet.  Don’t get me wrong, I appreciate what the boot has done for me the past six weeks, but it’s time. 

It feels great to reach another milestone and move on to the next phase of recovery.  Although very weak, my lower leg and tendon feel surprisingly well.  I’ve posted a couple of photos below to mark my progress at 12 weeks post-op.  My calf is withered (looks worse in person), but actually not as bad as I thought it might be following the second surgery.  I’m anxious to put it to work. 

Now that I’m happily back in two shoes I need to remind myself there is still quite a bit more time left in this battle.  I’m so ready to start running and jumping around, but I know I still need to be careful and take my time with re-stretching the tendon and building calf strength.  Baby steps will have to do for now.  Cheers!

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9 Weeks 1 Day Post Op

Tom Petty sure was right when he said “The waiting is the hardest part.”  I really wish I could fast forward to see the final results of the tendon shortening surgery.  I’m currently in my fourth week in the boot and desperate to start running and jumping around again.   Now that I’m past the critical time for wound complications and off the crutches I’m feeling good about my decision for a second surgery.  I likely won’t be any worse off than I was prior to the second surgery, but it will be several months until I know if my calf strength improves.  The wait goes on.

I’m going to PT once a week focusing on range of motion and isometric exercises to slowly build back strength in my ankle.  The therapist added in a few leg lift exercises this week to “wake up” the other leg muscles that haven’t been stimulated for a couple of months.

I got a bit nervous after my PT appointment last week when my dorsiflexion was measured at 8 degrees.  For reference, the uninvolved side is at 15 degrees.  The PT indicated this was okay, but he didn’t want too much more dorsiflexion at this point.  So, I slowed things down a bit and really tried to focus on minimizing any dorsiflexion past neutral.  I stayed off my bike trainer this past week and stuck to the at-home exercises.  I measured in at 6 degrees of dorsiflexion today, so I’m feeling a little better.  I’ll give the bike another go this week, making sure to use more of my heel on the pedal rather than forefoot.

Everything else has gone pretty well so far.  Having no pain and pretty good range of motion makes it tempting to push ahead.  But, given my situation, I’m content to progress at a slower pace, even if I have to endure the waiting.

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7 Weeks 2 Days Post Op

I had my first date with the physical therapist this morning.  Today’s session was just an opportunity for us to get to know each other a bit better.  It was pretty uneventful, but we’ve agreed to see each other again!

The PT logged in my history and did the assorted measurements to establish a baseline.  He seemed to be fine with how the ankle/tendon is progressing.  Per doctor’s orders, my initial sessions will only include basic isometric and range of motion exercises.  He is taking things slow to minimize the risk of the tendon elongating again.  I am certainly okay with this approach.  I was given a few take home exercises to work on until my next appointment and then sent on my way.

Overall things feel pretty good at this point.  My ankle has loosened up quite a bit since being released from the sometimes suffocating cast.  The tendon itself remains tight as I’m minimizing any dorsiflexion movements.  I continue to workout on my bike trainer, with the boot on, just to get the heart beating a little bit quicker.

Until next time, happy healing!

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6 Weeks Post Op

I went back to see the doc on Tuesday morning.  Cast #2 was removed and the surgeon reviewed my progress to date.  He seemed to be pleased with the results of the surgery and got me fitted into a walking boot.  I can ditch the crutches and begin full weight bearing as soon as I feel comfortable.

It was interesting to hear the surgeon stress how important the next several weeks will be.  I know this to be the case having gone through the recovery once before, but it was good for me to hear it again.  He commented that while the tendon is ready to bear weight, it is not fully healed at this point.  He also stressed the importance of gradual stretching of the tendon over the next several weeks to avoid unwanted slack.  Another point I was aware of as a lengthened tendon was the reason I needed a second surgery.

I can remove the boot while sitting, sleeping, and showering.  Careful shuffling to the kitchen or bathroom without the boot is permitted (the surgeon brought this up on his own without me asking), but otherwise I need to wear the boot if I’m moving about.  This is the plan for the next 6 weeks.  He wants to be a little cautious knowing this is the second surgery on the tendon.  But, he permitted all activities (biking, elliptical, etc.) as long as I’m in the boot.

The doc also gave me a prescription to start physical therapy.  Unfortunately the clinic must be pretty busy right now  as  I wasn’t able to get an appointment until next Friday.  But, I’ll start some basic range of motion exercises while I wait.

I was planning to spend a day or two transitioning off the crutches, but felt comfortable enough getting around the house this evening without them.  I have a bit of the usual pins & needles feeling in the bottom of the heal and the ankle joint is stiff, but I’ve already noticed improvements over the last 24 hours.  I also hopped on my bike trainer for a short spin the last two nights.  It felt good to get a little more exercise than just leg lifts and sit-ups.

Posted below is a picture of the incision at 6 weeks.  There are a couple of rough spots, but hopefully that will improve quickly now that I’m able to give it a massage. Cheers!

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As many of you already know, I’ve had the misfortune of spending a year and a half on the Achillesblog network.  Don’t get me wrong, I enjoy the comradery, it’s just that I didn’t expect to still be thinking and blogging about my Achilles tendon at this point.  Anyway, some time ago I added a poll to my blog that asked the question, “Did you take a fluoroquinolone type antibiotic (Cipro, Levaquin, Floxin, etc.) within a year of your Achilles tendon rupture?”  I believe this was first posted in July of 2008, around the time the US Food & Drug Administration ordered manufactures of fluoroquinolone type antibiotics to include a warning on the packaging regarding the possible side effects these antibiotics have on tendons.

I hadn’t paid too much attention to the poll, but given that there are now over 500 members on Achillesblog, I became curious about the results.  And, I have to say that I was pretty surprised.  One can obviously not draw too many conclusion from a one question survey, but I found it to be interesting nonetheless.

First, out of 105 votes placed through today, 42% responded that they had taken a fluoroquinolone antibiotic in the year leading up to their rupture.  I found this number to be quite a bit higher than I anticipated.  Given that the majority of AT injuries occur during some type of physical activity, I didn’t think antibiotics would play a significant roll.  I guess I figured this number would be in the 10-20% range.  I’m sure people who took an antibiotic prior to the AT rupture are probably more likely to respond to the poll, but the percentage is still surprising.

Second and even more surprising for me is the fact that this gives some indication of the frequency of which antibiotics are prescribed.  Just the idea that 42% of the 105 respondents took an antibiotic in the year leading up to the AT rupture is staggering.  I can’t help but think of what other negative effects antibiotics have on our bodies.  Perhaps they are an evil necessity if we want to rid ourselves of infection, but do we then just set ourselves up for other issues down the road?

If you haven’t already responded to the poll you can feel free to do so at any time.  Perhaps a larger sample size will have an effect on the results.  I’ll let the community know if there are any significant changes to the results.

Here are the current results:

Did you take a fluoroquinolone type antibiotic (Cipro, Levaquin, Floxin, etc.) within a year of your Achilles tendon rupture? Selection Votes Yes 42% 44 No 58% 61 105 votes total

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I picked up a copy of the Operative Report at my pre-op appointment last week.  I was curious to read more about the technique used to shorten my tendon.  The surgeon briefly described the procedure prior to the surgery, but sensing my confusion, he admitted it would be easier if he had a picture.  I scoured the internet in the weeks leading up to the surgery to find out more information on Achilles shortening surgeries, but found very little.  I believe the image below, one of the few I found, best illustrates the procedure my surgeon used.

The procedure is referred to as a z-shortening or z-plasty.  I believe the technique is actually used more for lengthening procedures, but apparently it works for shortening as well.  Basically, a short horizontal cut is made from the edge of the tendon towards the center.  The cut then turns vertically along the center of the tendon.  A second horizontal cut is made from the center towards the other edge.  The pattern of the cut resembles a “Z”, hence the name.  A small section of each end of the tendon is then removed and the ends are slid along the vertical plane until the proper tension is achieved.  Once the tension is set the tendon is sutured together with fiber wire.  Seems pretty simple.

I’ve set up a page that includes the operative report.  You can click on the link at the top of the site, or click HERE to read more details about the procedure.

You can also click HERE for an article that has a few more images of the z-shortening procedure.   Just click on the “Full Text” link on the right side of the page.  The pictures are about midway through the article.  Beware, a few images are a bit graphic.

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2 Week 1 Day Post Op

I had my first post-op visit  on Thursday morning, two weeks after surgery.  It was very uneventful, which is good.  The cast tech cut off my post-op cast and gave my foot a nice cleansing scrub.  A bit of fresh air felt wonderful.  Then the nurse came in and removed the stitches.  That was quick and painless.  Before I knew it I was back in a cast with my foot positioned a little closer to neutral and sent on my way.  I’m just shy of 90 degrees in the new cast.  The nurse felt I could stay in this one until I’m ready for the boot at 6-weeks post-op.  I have a feeling things might get a bit ripe being in the same cast for a month, especially with the warmer weather we’ve been experiencing.

The PGA Championship is being held close to home in the Twin Cities metro area this weekend.  So, to celebrate a new cast I headed out to catch the opening round with my father.  Maybe not my smartest move, but we had a fantastic time.  I wasn’t sure when I might have another chance to attend a major, so I decided to give it a go.  We were able to take a courtesy cart out to one of the far ends of the course, but ended up crutching my way around quite a bit of the course after that.  I’m paying for it today with sore hands and shoulders.  But, it was definitely worth every minute of the 7 hours we spent on the course.

Below is a picture of the incision after the cast came off and before the sutures were removed.  I was pleasantly surprised with size of the incision.  It wasn’t as large as I had feared.  I’m a bit nervous about a spot near the bottom of the incision that appears to be closing slowly.  Hopefully that won’t turn into a problem.  I may have to go in for a cast change just to make sure the wound continues to heal.  I did get a copy of my operative report and I will post that shortly along with a bit more information on the “shortening” procedure.

Incision at 2 Weeks Post-Op

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I made it back to the office full time starting this week.  I did go in for a half day last week and worked from home for a day as well to try and ease the transition.  But, I needed to get back to finish up a project.  The last two days have gone pretty well.  Most of my work is completed at a desk, in front of a computer, so I don’t feel I’m doing anything to slow my recovery.  I’m able to prop my leg up on my desk to keep it elevated, although that does spur numerous comments from my co-workers.  If only it was as comfortable as it probably looks.

Life in a cast has also brought on a Minnesota heat wave.  Just my luck.  We’ve had a very mild summer this year until this past week.  Temperatures are still pretty bearable, relatively speaking, but my leg has been a bit uncomfortable while trapped in the cast.   I’ll be happy when I go in on Thursday for a cast change.  My leg needs a few minutes to breathe.

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It’s almost been a week since the surgery to shorten my Achilles tendon.  Not a whole lot of news to report.  The most difficult time was waiting for the popliteal block to wear off.  I had reservations about the block while talking to the anesthesiologist because I didn’t like the thought of not being able to move my toes around and not knowing when the block would wear off.  But, I was kind of talked into it.  I didn’t really care too much for the anesthesiologist, but I digress.  I stayed up late the night after surgery hoping the block would wear off prior to going to bed, but I gave up at midnight.  Of course, I awoke in the middle of the night when the block finally wore off.  Fortunately the pain was manageable so I did fall back asleep after a little bit of tossing and turning.

I took Percocet the day after surgery, but didn’t care much, at the time, for the altered state of mind.  The pain wasn’t too bad so I switched over to acetaminophen the next day.  By day three I was basically drug free.  I hardly put a dent in the 90-tablet Percocet prescription.  Seriously, the clinic handed me 90 Percocet tablets.  A bit excessive, maybe?  I guess I know how I’ll be paying for this surgery if it doesn’t get covered under my insurance.

I’ve spent most of the last week reading magazines and using the “watch instantly” feature on Netflix.  I’ve watched a few movies that have been more painful than the surgery.  But, it’s been nice to kick my foot up, keeping the swelling at bay.  I may try to stop in the office for a few hours at the end of the week, but I want to make sure I give the incision a chance to heal before I try to do too much.  We’ll see how I do over the next day or two.

My cast has been a bit uncomfortable so far.  I haven’t figured out the exact source.  It may just be from the swelling following surgery.  Hopefully it won’t drive me completely crazy before I go in for my first cast change next week.  I am anxious to get a look at the incision.  It’s a little unsettling just assuming everything is healing fine.  I hope that is the case.  I’ll let you know after my first post-op visit next week.

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Well, I made it through surgery today.  From all accounts it sounds like it went pretty well.  Knowing a bit more of what to expect this time kept me a little less anxious.  I was even able to crack a few jokes with the staff prior to the drugs taking affect.  My fiance was able to speak with the surgeon following the procedure and he was happy with how things went.  The surgeon reported that the tendon was very healthy although he shaved off quite a bit of scar tissue from the original surgery prior to the shortening.  He did not need the FHL transfer/augmentation because the tendon was healthy.

I opted for the spinal block versus the general anesthesia this time.  I haven’t had any problems with general in the past, but I thought I’d give the spinal block a try.  I think it was a good choice as I came to much quicker  following the surgery and so far I’ve felt a bit more alert considering I just had surgery.  They also gave me a popliteal block for post-op pain management.  Not sure I care too much for this.  While I’m not currently in any pain, I  wish I was able to move my toes.  It feels like my foot has been asleep for the past 8 hours.  Hopefully it will wear off soon, although I should probably be careful of what I wish for.

I took a couple of pre-op photos so that I’ll have something to chart my progress once I’m able to start weightbearing again.  The photos are approximate 1.5 years after the original surgery.  It’s easy to see that my right calf never regained much mass, especially on the medial side.

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I met again with the surgeon on Tuesday.  We reviewed the results of the MRI and had a good discussion regarding the pros and cons of a surgical procedure to shorten my elongated Achilles tendon.  The MRI didn’t show much other than a very thick tendon.  That wasn’t a surprise as that is clear to the naked eye.  The doc did point out two small spots along the tendon which he thought were pockets of fluid, but he didn’t seem overly concerned.  Otherwise, the tendon looked healthy, which I’m assuming is a good sign in the grand scheme of things.

I was able to get all my questions answered and I appreciated the surgeon’s time and frankness.  Although it’s somewhat difficult to accept, I’m pretty certain a second surgery is my only option for regaining anymore strength in my calf.

There are two mental challenges for me with this surgery.  The first is that I feel I’ve seen the slightest bit of improvement over the last few months.  It seems like a little more strength has returned to the calf.  But, relatively speaking, the calf is no where near where it should be, now over 18 months since the original surgery.

The second challenge is the thought of walking into the hospital knowing that I’ll be leaving on crutches.  Seems so cruel.  But, I remind myself that the short term agony of a cast and crutches will be worth the ability to regain more calf strength and feel a little bit closer to normal.

My surgery is scheduled for Wednesday.  Hopefully all goes well.

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I was pretty confident that my last post, 7 months ago, would be the final time I blogged about my Achilles tendon. But, here I am with another post. Why, you ask? Well, my recovery has taken a new twist. It appears that I may be suffering from an elongated tendon.

My recovery went relatively well, but I’ve struggled to regain strength in my calf. Even after spending countless hours at the gym focusing on calf exercises along with mile after mile of running and biking, there was still very little mass to my calf muscle.

At first I chalked up the situation to the injury and long recovery time. Most information I read mentioned the recovery can take up to a year. But, I started to get more concerned when my one year anniversary came and went this past January and my calf was still weak. I decided to consult the internet for additional information. Although the information was sparse, I concluded that my Achilles tendon may have elongated at some point either during or after the initial repair.

I knew I wasn’t doing any more harm to the tendon, so before returning to the doctor I thought I would change up my exercise routine in hopes that my calf muscle would suddenly wake up. To start, I decided to stop my leg workouts and give my calf some rest. I took a 6 to 8 week hiatus from calf exercises as well as running from January to March. Towards the end of March I eased back into the calf exercises and running.

Over the next several months I noticed slight improvement, but I knew my calf strength was still not close to where it needed to be. So, in June I finally raised the white flag of surrender and set up an appointment with a foot and ankle specialist. It didn’t take long for the doctor to confirm what I had feared – an elongated Achilles.

According to the doctor, the only way to regain more strength is to surgically shorten the tendon and start the recovery process all over again. After spending a few weeks weighing the pros and cons of another surgery, I set up a date with the surgeon. I also have an MRI scheduled tomorrow so the surgeon has a better idea what he’s working with. Assuming the MRI confirms the surgeon’s diagnosis, I’ll go under the knife again at the end of July.

While I’m not excited about the prospect of another surgery and starting the recovery all over again, I also don’t like the idea of living the rest of my life with a weakened calf muscle. My intuition tells me that a weak calf muscle will probably lead to problems with my knees or back at some point down the road. So, I guess I’m considering this surgery as “preventative”. It looks like I will once again be lining up at the starting line to the virtual achillesblog marathon.

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